Quality of care and costs for peripheral artery disease sufferers differ in the USA

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Although minimally invasive treatments for patients with peripheral artery disease result in shorter hospital stays and the potential to save US Medicare millions of dollars each year, a new study reveals that the quality of care and cost depend on who is providing the treatment.

The study, which appears in the January issue of the Journal of Vascular and Interventional Radiology, is the first and largest study of its kind on these treatments for Medicare patients age 65 and older.


 

“Identifying quality health care and cost savings for treating a disease that affects millions of Americans is critical,” said Marshall Hicks, president-elect of the Society of Interventional Radiology. “This study can help consumers understand that different doctors get different outcomes for the same treatments—and that they have a choice,” said Hicks, an interventional radiologist and head of the diagnostic imaging division at the University of Texas, Anderson Cancer Center in Houston.

 


According to the Society of Interventional Radiology, peripheral artery disease affects an estimated 10 million people in the United States (12–20 % of Americans over age 65) and can lead to heart attack or stroke.

 


Researchers in the study reviewed Medicare claims data from more than 14,000 patients with peripheral artery disease over two years from Medicare’s Standard Analytical Files, which present a large dataset that contains all services (physician, inpatient, and outpatient). The authors compared outcomes of percutaneous (procedures done through the skin) peripheral artery disease treatments in Medicare patients according to the physician specialty type (interventional radiologist, interventional cardiologist, vascular surgeon) that provided the service and assessed mortality, transfusion, intensive care use, length of stay, and subsequent restoration of blood supply or amputation. Outcomes were compared using standard outcome prediction formulas adjusted for age, gender, race, emergency department admission and other existing conditions.

 


“We found that costs and provider care are not alike,” said current society president Timothy P Murphy, a study co-author. “We noted that the adjusted average one-year procedure cost when performed by interventional radiologists was about US$17,640. That is a cost savings to Medicare of approximately US$1,000 per procedure—which means that in such a large population, treatments for peripheral artery disease by interventional radiologists could potentially save taxpayers US$230 million each year. And the patient outcomes are better,” said Murphy, an interventional radiologist and director of the Vascular Disease Research Center at Rhode Island Hospital in Providence, USA.

 


Murphy noted that data from the study provided strong evidence that treatment by interventional radiologists gives numerous benefits to the peripheral artery disease patient, such as less risk of infection, less anesthesia, less pain and scarring, faster recovery and a quicker return to normal activities. “The Medicare data clearly show more transfusion and intensive care utilisation, longer length of stay, more repeat procedures or amputations and higher costs when treatment is not performed by interventional radiologists,” Murphy added.